Method of analyzing vertebral edges of vertebrae in images acquired from an upright MRI system

ABSTRACT

A method of analyzing a spinal region of a subject. The method includes steps of obtaining a first sagittal image of the spinal region of the subject using an upright magnetic resonance imaging unit; identifying a first vertebral edge on a first side of a first disc in the first sagittal image; identifying a second vertebral edge on a second side of the first disc in the first sagittal image; and determining a first angle between the first vertebral edge and the second vertebral edge for the first disc.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. Non-Provisional applicationSer. No. 15/382,188, filed Dec. 16, 2016, which is a continuation ofU.S. Non-Provisional application Ser. No. 14/941,003, filed Nov. 13,2015, which is a continuation of U.S. Non-Provisional application Ser.No. 13/801,457, filed Mar. 13, 2013, and which claims the benefit ofU.S. Provisional Application No. 61/658,671, filed Jun. 12, 2012, theentire contents of each application is incorporated herein by referencein their entirety.

BACKGROUND OF THE INVENTION

The present invention relates to analysis of data obtained from asubject obtained using a magnetic resonance imaging (MRI), in particularan upright MRI.

Magnetic resonance imaging (MRI) permits imaging of internal structuresin a subject's body and is especially useful for studying soft tissues.Among the body structures that can be visualized are the vertebrae, thediscs between vertebrae, and related structures. However, when a subjectis lying on his or her back, as is the case with conventional MRIdevices, the weight and stresses that the vertebrae are normallysubjected to are not present and thus the observations and diagnoses arenot as accurate as they otherwise could be.

SUMMARY OF THE INVENTION

In one embodiment, the invention provides a method of analyzing a spinalregion of a subject. The method includes steps of obtaining a firstsagittal image of the spinal region of the subject using an uprightmagnetic resonance imaging unit; identifying a first vertebral edge on afirst side of a first disc in the first sagittal image; identifying asecond vertebral edge on a second side of the first disc in the firstsagittal image; and determining a first angle between the firstvertebral edge and the second vertebral edge for the first disc.

In another embodiment the invention provides a computer-based system foranalyzing a spinal region of a subject. The system includes an uprightmagnetic resonance imaging system, a processor, and a storage mediumoperably coupled to the processor. The storage medium includes programinstructions executable by the processor for generating a sagittal imageof a spinal region from data obtained using the upright magneticresonance imaging system; facilitating identification of a firstvertebral edge on a first side of a first disc in the sagittal image;facilitating identification of a second vertebral edge on a second sideof the first disc; and determining an angle between the first vertebraledge and the second vertebral edge for the first disc.

Other aspects of the invention will become apparent by consideration ofthe detailed description and accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram for a system for obtaining and analyzing datafrom an upright MRI unit.

FIG. 2 shows a portion of a spinal column of a human subject.

FIG. 3 shows additional anatomical structure of a vertebra.

FIG. 4 shows a human subject in various positions in an upright MRIunit.

FIG. 5 shows a screen shot of a software system for data collection andanalysis.

FIG. 6 shows another screen shot of a software system for datacollection and analysis.

DETAILED DESCRIPTION

Before any embodiments of the invention are explained in detail, it isto be understood that the invention is not limited in its application tothe details of construction and the arrangement of components set forthin the following description or illustrated in the following drawings.The invention is capable of other embodiments and of being practiced orof being carried out in various ways.

In some embodiments, the invention includes a system 100 for obtainingand analyzing data. The system 100 (FIG. 1) can include an uprightmagnetic resonance imaging (MRI) unit 110, a controller 120 operativelyconnected to the MRI unit 110, and one or more computer system 130operatively connected to the MRI unit 110 to obtain and analyze imagedata. In various embodiments, the components shown in FIG. 1 may be inone unit or multiple units and some of the elements may be remotelylocated from others, for example the computer system 130 may beintegrated with the MRI unit 110 and controller 120 or may be located atsome distance from the MRI unit 110 and/or controller 120, e.g. a shortdistance away (for example in the same room or building) or much further(e.g. many miles) away. Further, the controller 120 may be integratedwith the MRI unit 110 or may be located a short distance or much furtheraway. The controller 120 of the system 100, in various embodiments, maybe programmed to carry out one or more steps of the methods describedherein, including steps related to data collection, processing, storage,and analysis.

The components of the system 100, which may encompass one or morecomputer system 130, may be in communication with one another throughvarious wired and wireless communication means which may includecommunications through the Internet (FIG. 1). Each computer system 130may include an input device, an output device, a storage medium, and aprocessor. Possible input devices include a keyboard, a computer mouse,a touch screen, and the like. Output devices may include a cathode-raytube (CRT) computer monitor, a liquid-crystal display (LCD) or LEDcomputer monitor, and the like. Storage media include various types ofmemory such as a hard disk, RAM, flash memory, and other magnetic,optical, physical, or electronic memory devices. The processor may beany typical computer processor for performing calculations and directingother functions for performing input, output, calculation, and displayof data in the disclosed calculator. Implementation of the system 100includes generating a set of instructions and data that are stored onone or more of the storage media and operated on by a controller. Thedata associated with the system 100 can include image data and numericaldata.

In some embodiments, the system 100 may include a web page forfacilitating input, control, analysis, and other functions. In otherembodiments, the system 100 may be implemented as a locally-controlledprogram on a local computer system 130 which may or may not beaccessible to other computer systems. In still other embodiments, thesystem 100 may include modules which provide access to portable devicessuch as laptops, tablet computers, and smart phones.

In certain embodiments, the invention may include a computer-readablemedium, which may include, for example, storage media as describedabove, where the computer readable medium may include instructions tocarry out one or more steps of the methods described herein, includingsteps related to data collection, processing, storage, and analysis.

In various embodiments, the invention includes a method of analyzing aspinal region of a subject. The subject may be a human or othervertebrate animal, and in various embodiments the subject is a mammal.The subject may have pain, including chronic pain, where the methods ofthe invention may include identifying one or more structures (e.g. inthe subject's spinal column or related anatomical structures) which areabnormal and which might require treatment to alleviate the subject'sdiscomfort and/or restore the structures to a more normal condition.

Among the structures that can be imaged and analyzed according tomethods of the invention are shown in FIG. 2, which shows a portion of aspinal column of a human subject including several vertebrae. Thesestructures include a body 270 of a vertebra as well as a facet joint 280and a normal disc 210. In addition to the normal disc 210, FIG. 2 alsodepicts several abnormal discs, including a degenerated disc 220, abulging disc 230, a herniated disc 240, a thinning disc 250, and discdegeneration along with osteophyte formation 260. Additional structuresof the vertebrae are shown in FIG. 3, including the spinous process 310,the transverse process 320, the superior articular process 330, theforamen 340, the body 270, and the pedicle 350. The methods can be usedto analyze and diagnose conditions from any portion of the spinalcolumn, including vertebrae from the cervical, thoracic, or lumbarregions.

The method includes obtaining a first image of the spinal region of thesubject using an upright MRI unit. The use of upright MRI imaging has adistinct unparalleled role in the evaluation and understanding of backpain. An understanding of functional discal alteration is difficult tounderstand in the normal recumbent posture examination. The weightbearing examination is the most functionally accurate way to understandthe vertebral body and discal position in the biped posture. While ingeneral the methods of the invention are performed using an upright MRI,in some embodiments a conventional MRI unit may be used instead. In someembodiments, other medical imaging techniques, including CT scans andconventional x-rays, may be used instead of or in addition to MRI. Invarious embodiments, one or more contrast agent suitable for theparticular imaging method may be used in order to improve visualizationof key anatomical structures.

An upright MRI unit is particularly suitable for the present methodsbecause it permits the subject to stand or sit in an upright ornear-upright position during image collection, such that the images ofthe spinal region show the anatomical structures as they are under theirnormal weight-bearing stresses (FIG. 4). The subject may be positionedin different ways by the operator (e.g. technician or other medicalprofessional) prior to image collection in order to obtain data from aparticular viewpoint. Among the positions that the subject may be placedin (particularly a human subject) are: a standing neutral position (i.e.not bending in any direction); a standing extension position (i.e.bending backward); a standing flexion position (i.e. bending forward); astanding left lateral bending position; a standing right lateral bendingposition; a standing left rotation position; and a standing rightrotation position. Other positions, including seated positions, are alsopossible.

MRI images are then acquired with the subject in one or more position,generally different positions from one another. The MRI image mayinclude a full volume of data covering some or all of the spinal regionof the subject, or the data may be a limited portion such as a slice ina coronal, sagittal, or axial plane. In various embodiments, data from afull volume may be processed to generate one or more views in a coronal(i.e. as viewed from the front of a human subject), sagittal (i.e. asviewed from the side of a human subject), or axial (i.e. as viewed fromthe top of a human subject) plane, or another plane that is suitable forthe particular analysis that is required.

The body 270 of each vertebra has an upper and lower surface that isadjacent to a disc. When viewed from the side (i.e. in a sagittal view),the upper and lower surfaces of each vertebral body 270 appear as edges,where the upper edge of one vertebral body 270 and the lower edge of anadjoining vertebral body 270 define a space in which the disc 210 islocated. Measuring the distances and angles between these edges,particularly when measurements are obtained from the subject in severaldifferent positions, can be used to identify abnormalities in thesubject's spinal column. These abnormalities may in turn be connectedwith pain or discomfort that the subject is experiencing and might beused to determine treatment to alleviate the pain or discomfort.

In addition to the angles and distances between vertebral bodies 270,image data can also be used to identify the overall condition of thediscs 210, in particular to identify one or more possible conditions ofthe discs such as those shown in FIG. 2 and described above. Additionalinformation regarding the condition of the discs can also be obtained bycomparing images obtained when the subject different is in differentpositions, as the discs may appear normal in one position and abnormal(e.g. bulging) when the subject is in a different position.

Further information that can be obtained from the images can be used toassess the condition of the subject's facet joints 280, for example toidentify degeneration, particularly when comparing images that areacquired from the subject in several different positions.

In various embodiments, the angles between adjoining vertebral body 270surfaces may be carefully measured to determine whether any of thevertebrae are out of alignment with respect to one another. Using asagittal (side view in the case of a human subject) image, the anglebetween adjoining vertebral body 270 surfaces can be assessed in ananterior-posterior direction. Similarly, from a coronal (front view inthe case of a human subject) image of the subject, the angles betweenadjoining vertebral body 270 surfaces can be measured to determine theextent to which the surfaces are not aligned. In some embodiments, theangles between adjoining vertebral body 270 surfaces can be measured towithin one-tenth of a degree, and the measurement may note how manydegrees the surfaces are opened, either in an anterior or a posteriordirection. The mensuration of the discs in the sagittal and coronalimages for wedging in left/right and the anterior/posterior planes aremeasured by degrees of opening. This allows small degree ofintersegmental disruption to be detected and reevaluated on follow upexamination. The mensuration is evaluated without false clinicalperception.

Information that can be obtained from either or both of the sagittal orcoronal images is the thickness of the disc, which in variousembodiments can be measured to within one tenth of a millimeter. Discvolume is also measured by the AP diameter and the width of the discherniation. This can be evaluated in the neutral and motion examination.Motion studies in flexion/ extension and left and right lateral bendingdemonstrate information twofold: 1. Changes in the degrees of opening inthe anterior/posterior and the left and right lateral bending. Thismotion can occur within normal expected direction of motion orparadoxical motion. 2. There is also evaluation of disc stability inthese excursions which is either stable or unstable in the motionplanes. This has been termed “dynamic discal alteration”. This caneither increase or reduce the prominence of the discal pathology duringdifferent excursion.

Using axial (top view in the case of a human subject) images, thecondition of the foramen 340 can be evaluated, in particular to see ifthe foramen 340 is ‘patent,’ meaning unobstructed.

In one embodiment, the image data obtained from the subject is analyzedusing a computer system 130 such as described above (FIGS. 5-6).Information such as thickness and condition of discs, foramen, facetjoints, and angles between adjoining vertebral body surfaces may beobtained using automated methods, e.g. using image processing andautomated detection of structures and subsequent calculation of data, ormanual analysis, or a combination of automated and manual dataextraction and analysis. In various embodiments, the information fromanalyzing one or more views obtained from the subject is used todiagnose the subject and/or plan treatment or select a treatmentprotocol. The disclosed methods may also be used for follow-up diagnosisof the subject's condition, the results of which may be used to alterthe subject's treatment.

In one particular embodiment, data obtained from measurements of thesubject's discs, e.g. discs in the lumbar or cervical region, areentered into a computer system which then further processes the data andprovides information to a clinician or other medical professional. Forexample, as shown in FIG. 5, data regarding the angles between adjoiningvertebral body 270 surfaces for one or more adjacent are entered into aspreadsheet-like interface. The particular discs are identifiedaccording to the vertebrae that each is located between, for example ‘½’indicates the disc found between the L1 and L2 lumbar vertebrae on theLower Back Analysis Chart shown in FIG. 5. In addition to the angles,also entered is an indication of what direction the angle is facing,such as ‘A’ for anterior and ‘P’ for posterior for angles measured in asagittal view or ‘R’ for right and ‘L’ for left in a coronal view.

For a given view (e.g. sagittal, coronal, or axial), image data may becollected and analyzed with the subject in a ‘neutral’ position (e.g.sitting or standing upright) as well as in a ‘bending’ position. Invarious embodiments, the data corresponding to the neutral position islabeled ‘sagittal,’ ‘coronal,’ or ‘axial.’ The respective ‘bending’positions are labeled accordingly (e.g. ‘flexion’ and ‘extension’ forsagittal views, ‘left lateral’ and ‘right lateral’ for coronal views).For each of the bending positions, in some embodiments additionalinformation is obtained and recorded regarding the change in appearanceof the corresponding discs, namely whether the appearance is better(marked ‘B’) or worse (marked ‘W’) when the patient bends in the givendirection. The indication of better or worse may be determined byassessing whether a bulging or herniated disc protrudes outward less(generally considered better) or more (generally considered worse) whenthe patient bends in the given direction. Finally, an overall diagnosisfor the particular disc may be noted in the same row with the otherdata. In some embodiments, the computer system provides a Change Trackerwindow which shows the degree of change in the opening of the particulardisc as the data is entered, for example the number of degrees ofangular change and the direction of the change (e.g. anterior orposterior for sagittal views). Other features that may be provided inother embodiments include a list of patients for whom data is availableor for whom new data is to be entered, as well as a control panelincluding on-screen buttons to select functions including Report,Compute, Refresh, Submit, Reset, Delete, and Retrieve.

FIG. 6 shows a screen shot of a data summary report provided in variousembodiments of the computer system. In the example shown in FIG. 6, dataeach for the discs L1-L5 include opening angles for the neutral sagittal(NS) view, flexion (F) view, the change between the neutral and flexionviews (ΔF), an indication of whether the condition of the disc (e.g.herniation or bulging) is better (B) or worse (W) upon flexion, as wellas comparable data for extension (E), change between the neutral andextension views (ΔE), and an indication of whether the disc appearsbetter or worse upon extension. The data regarding angles also includesan indication of whether the angle is in the anterior (A) or posterior(P) direction.

Similar information may be provided for data obtained in coronal andaxial views. FIG. 6 shows data for the neutral coronal (NC) view, leftlateral (LL) view, the change between the neutral and left lateral views(ΔLL), right lateral (RL) view, the change between the neutral and rightlateral views (ΔRL), and in each case an indication of whether the disccondition is better (B) or worse (W). Finally, a summary chart mayinclude notes concerning a possible diagnosis as well as otherinformation (e.g. measurements of disc protrusions, if any, that arenoted).

In other embodiments the computer system includes screens for enteringand displaying data corresponding to other regions of the subject's backincluding the cervical region.

As discussed above, this information is then used by a medicalprofessional to diagnose the subject's condition and, in variousembodiments, design a treatment regimen. Similar measurements may beused at various times to assess the effectiveness of the treatmentregimen.

Thus, the invention provides, among other things, a method and systemfor obtaining and analyzing data from an upright Mill from the spinalregion of a subject. Various features and advantages of the inventionare set forth in the following claims.

What is claimed is:
 1. A method of analyzing a spinal region of asubject, the method comprising: obtaining a first image of the spinalregion of the subject using an upright magnetic resonance imaging unit;identifying a first vertebral edge on a first side of a first vertebrain the first image; identifying a second vertebral edge on a first sideof a second vertebra adjacent to the first vertebra in the first image;identifying a third vertebral edge on a second side of the secondvertebra in the first image; identifying a fourth vertebral edge on afirst side of a third vertebra adjacent the second vertebra in the firstimage; determining a first angle between the first vertebral edge andthe second vertebral edge; determining a second angle between the thirdvertebral edge and the fourth vertebral edge; determining whether thefirst vertebra, the second vertebra, and the third vertebra are inalignment based on the first angle and the second angle.
 2. The methodof claim 1, wherein the first image comprises an image of a lumbar discbetween the first vertebral edge and the second vertebral edge.
 3. Themethod of claim 1, wherein the first image comprises an image of acervical disc between the first vertebral edge and the second vertebraledge.
 4. The method of claim 2, further comprising identifying athickness of the lumbar disc.
 5. The method of claim 1, furthercomprising determining a size of a first disc positioned between thefirst vertebral edge and the second vertebral edge, wherein determininga first size of the first disc includes identifying a diameter of thefirst disc.
 6. The method of claim 5, further comprising identifying acondition of the first disc, the condition being selected from the groupconsisting of herniated, thinned, bulging, degenerated, and normal. 7.The method of claim 1, wherein the subject is in a first position whenobtaining the first image of the spinal region of the subject using anupright magnetic resonance imaging unit.
 8. The method of claim 7,further comprising obtaining a second image of the spinal region of thesubject using an upright magnetic resonance imaging unit, wherein thesubject is in a second position, different from the first position. 9.The method of claim 1, further comprising identifying a condition of afacet from the first image.
 10. The method of claim 1, furthercomprising obtaining a coronal image.
 11. The method of claim 1, furthercomprising positioning a subject in a position selected from the groupconsisting of standing neutral, standing extension, standing flexion,standing left lateral bending, standing right lateral bending, standingleft rotation, and standing right rotation.
 12. The method of claim 1,further comprising diagnosing a spinal pathology based on whether thefirst vertebra, the second vertebra, and the third vertebra are inalignment.
 13. The method of claim 12, further comprising prescribing atreatment protocol for the subject based on the diagnosis.
 14. Themethod of claim 1, wherein at least one step is conducted using amicroprocessor.
 15. A computer-based system for analyzing a spinalregion of a subject, comprising: an upright magnetic resonance imagingsystem; a processor; and a storage medium operably coupled to theprocessor, wherein the storage medium includes program instructionsexecutable by the processor for generating a first image of a spinalregion from data obtained using the upright magnetic resonance imagingsystem; facilitating identification of a first vertebral edge on a firstside of a first vertebra in the first image; facilitating identificationof a second vertebral edge on a first side of second vertebra in thefirst image; facilitating identification of a third vertebral edge on asecond side of the second vertebra in the first image; facilitatingidentification of a fourth vertebral edge on a first side of a thirdvertebra in the first image; and determining a first angle between thefirst vertebral edge and the second vertebral edge; determining a secondangle between the third vertebral edge and the fourth vertebral edge;determining whether the first vertebra, the second vertebra, and thethird vertebra are in alignment based on the first angle and the secondangle.
 16. The system of claim 15, further comprising determining a sizeof a first disc positioned between the first vertebral edge and thesecond vertebral edge, wherein determining a size of the first discincludes identifying a diameter of the first disc.
 17. A method ofanalyzing a spinal region of a subject, the method comprising: obtaininga series of images of the spinal region of the subject using an uprightmagnetic resonance imaging unit; determining a first angle between afirst vertebral edge of a first side of a first vertebra and a secondvertebral edge of a first side of a second vertebra; determining asecond angle between a third vertebral edge of a second side of thesecond vertebra and a fourth vertebral edge of a first side of a thirdvertebra; and determining whether the first vertebra, the secondvertebra, and the third vertebra are in alignment based on the firstangle and the second angle.
 18. The method of claim 17, furthercomprising diagnosing a spinal pathology based on whether the firstvertebra, the second vertebra, and the third vertebra are in alignment.19. The method of claim 18, further comprising generating a treatmentprotocol for the subject based on the diagnosis.
 20. The method of claim17, further comprising determining a size of a first vertebral discpositioned between the first vertebral edge and the second vertebraledge, wherein determining a size of the first vertebral disc includesidentifying a diameter of the first vertebral disc.